Anti-NMDA-receptor antibody detected in encephalitis, schizophrenia, and narcolepsy with psychotic features

Akita University, Department of Neuropsychiatry, Akita, Japan. .
BMC Psychiatry (Impact Factor: 2.21). 05/2012; 12(1):37. DOI: 10.1186/1471-244X-12-37
Source: PubMed


Causative role of encephalitis in major psychotic features, dyskinesias (particularly orofacial), seizures, and autonomic and respiratory changes has been recently emphasized. These symptoms often occur in young females with ovarian teratomas and are frequently associated with serum and CSF autoantibodies to the NMDA receptor (NMDAR).
The study included a total of 61 patients from age 15 to 61 and was carried out between January 1, 2005, and Dec 31, 2010. The patients were divided into the following three clinical groups for comparison. Group A; Patients with typical clinical characteristics of anti-NMDAR encephalitis. Group B; Patients with narcolepsy with severe psychosis. Group C; Patients with schizophrenia or schizo-affective disorders.
Ten out of 61 cases were anti-NMDAR antibody positive in typical encephalitis cases (group A: 3 of 5 cases) and cases in a broader range of psychiatric disorders including narcolepsy (group B: 3 of 5 cases) and schizophrenia (group C: 4 of 51 cases).
In addition to 3 typical cases, we found 7 cases with anti-NMDAR antibody associated with various psychotic and sleep symptoms, which lack any noticeable clinical signs of encephalitis (seizures and autonomic symptoms) throughout the course of the disease episodes; this result suggest that further discussion on the nosology and pathophysiology of autoimmune-mediated atypical psychosis and sleep disorders is required.

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Available from: Keiko Tanaka, Dec 13, 2013
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    • "A Japanese group found anti-NMDAr antibodies in 4 of 51 schizophrenic patients. They reported also three of five hypocretin deficient narcolepsy patients with severe psychosis (13). Immunomodulatory treatment in narcolepsy has provided rather poor results (14). "
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    • "Healthy controls 230 36 (12) 159 (69) .. .. Dickerson et al. (2013) Acute mania b 57 35 (13) 16 (28) .. .. Schizophrenia or schizoaffective disorder (multi-episode, chronic) 234 42 (12) 137 (59) .. .. Bipolar disorder (acute depressive state) 28 38 (14) 6 (21) .. .. Healthy controls 207 33 (11) 80 (39) .. .. Haussleiter et al. (2012) Schizophrenia (NR) 44 43 (13) 15 (34) 21 (7) Schizoaffective disorder (NR) 4 45 (7) 1 (25) 13 (3) Tsutsui et al. (2012) "
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    • "Several mechanisms may explain the epidemiologic data [Strous and Shoenfeld, 2006]. Individuals with auto-immune diseases have elevated prevalence of antibodies directed against brain proteins or may produce antibodies that cross-react with brain proteins [Irani and Lang, 2008]; individuals with SZ can also produce antibodies against proteins in the frontal cortex [Henneberg et al., 1994], cingulate gyrus [Ganguli et al., 1987; Kelly et al., 1987; Henneberg et al., 1994], hippocampus [Ganguli et al., 1987] and against glutamate receptors [Tsutsui et al., 2012]. Individuals with autoimmune disorders also develop further CNS dysfunction in conjunction with microbial infections [Benros et al., 2011]. "
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